Gonadotrophins can be used to treat fertility problems in both men and women; helping women to ovulate and improving the sperm count for men.

Who might benefit?

These drugs are most often given to women with polycystic ovary syndrome who have either not responded at all to clomifene or have not become pregnant, even though they have ovulated in response to clomifene. Other possibilities include women with unexplained infertility and those about to embark on assisted conception treatment.

Gonadotrophins can also help men who have a hormonal imbalance (that originates in the pituitary gland or hypothalamus) linked to a low sperm count, or poor sperm quality or motility (its ability to move).
How does it work?

Human Menopausal Gonadotrophin (hMG) is a mixture of two hormones that are crucial for ovulation to take place: luteinising hormone (LH) and follicle stimulating hormone (FSH). HMG directly stimulates the ovaries to produce and mature eggs.

Some drugs now contain purified FSH only to achieve the same results, causing fewer side effects. These drugs are given in conjunction with another drug called human chorionic gonadotrophin (hCG), which triggers the release of the mature eggs.

A course of injections makes your ovaries start developing and maturing egg follicles. After seven to 12 days of these injections, you'll get an injection of human chorionic gonadotrophin (hCG), which tells your ovaries to release the egg or eggs they have just developed.

How long will the treatment take?

Treatment can begin any time you're not ovulating and continue daily for seven to 12 days each month, depending on how long it takes for your eggs to mature. Your doctor might teach you or your partner to give the injections so you don't have to travel to their surgery or clinic every day.

While you're having the injections, your doctor will monitor you to see when you're likely to ovulate, so frequent internal examinations, trans-vaginal ultrasounds and blood tests are often necessary. When the ultrasound shows that your eggs are mature, you will be given an injection of hCG to trigger ovulation.

Ovulation usually occurs 24 to 36 hours after the hCG injection. You're either sent home to have sex afterwards or an intrauterine insemination is scheduled for a day or two later.

Most women go through a maximum of three to six drug cycles. Success rates don't improve if you take the drugs for any longer, so if you try three times or more and don't get pregnant, your doctor may increase the dose or suggest another kind of treatment.

Are there any side effects?

Many women notice blurred vision, abdominal tenderness, bloating, fluid retention and weight gain. It can also be difficult to give yourself an injection. The newer, purer gonadotrophins cause fewer side effects and can be injected using smaller needles subcutaneously (under your skin) rather than into your muscle, which requires a long needle.

Taking these fertility drugs can be a very emotionally intense process as, in addition to all the injections, you need to have frequent monitoring.

In about three per cent of cycles with hMG, women develop ovarian hyperstimulation syndrome (OHSS). This is a potentially fatal condition signalled by the sudden onset of severe abdominal pain, nausea, vomiting, dehydration, headaches and weight gain. The ovaries rapidly swell to several times their usual size (due to an excessive number of eggs) and may leak fluid into the abdominal cavity.

If it becomes clear that your ovaries are developing too many eggs, you will be advised not to have sex or to exercise strenuously because of the risks of a high-order multiple pregnancy. It's disappointing to abandon a cycle but worth being cautious as such pregnancies carry high risk of complications.

What are the risks?

Even with the best monitoring and medical decision-making, multiple pregnancies and OHSS can happen. The rates for multiple pregnancy as the result of taking fertility drugs such as hMG is around one in three. It’s important to consider the risks carefully before embarking on these treatments.

Fertility drugs such as hMG don't significantly increase a woman's risk of developing ovarian cancer, even if she takes them for more than a year. This issue was previously a major source of concern, but it now seems that it’s the underlying causes of fertility problems (such as endometriosis) that may increase the risk of ovarian cancer, rather than the drugs used to treat them.

What is the success rate?

Results from some of the larger studies included in a major review suggest that about 70 to 85 per cent of women will ovulate on these drugs, and that around 7 to 14 per cent will get pregnant.Buy hmg injections

Factors affecting the pregnancy rate include the time in your cycle you have sex, your age, and the speed and motility of your partner's sperm. Talk to your doctor about your chances of success on these drugs so that you can weigh up the benefits and the risks as best you can before beginning treatment.